Provider Demographics
NPI:1679023378
Name:BEHAVED BRAIN
Entity Type:Organization
Organization Name:BEHAVED BRAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GATELY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:201-857-5380
Mailing Address - Street 1:216 DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4400
Mailing Address - Country:US
Mailing Address - Phone:201-857-5380
Mailing Address - Fax:201-857-5379
Practice Address - Street 1:216 DAYTON ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4400
Practice Address - Country:US
Practice Address - Phone:201-857-5380
Practice Address - Fax:201-857-5379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00437800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty